October 18, 2001

House Committee Meets In Memphis To Discuss State's Nursing Home Issues

Several area witnesses painted a problematic picture regarding the future of the nursing home industry for members of the House Select Committee on Nursing Home Care, which met at the Memphis Theatre October 15.

Representatives from several local care centers spoke to the 10-panel committee chaired by First District State Representative Sam Berkowitz. They discussed several troubling issues including declining revenue, deficit Medicaid reimbursement, shrink-ing labor force and growing governmental regulations.

Richard Dunn of the Department of Health and Senior Services told the committee of the state's 1,200 nursing homes and the likely impact that a growing senior citizen population will have on the industry. He noted there are currently as many as 21,000 empty beds in nursing homes and residential care facilities in the state.

"That creates a false sense of security as we will be pressed for services as the growing senior population arrives," Dunn stated.

Currently Missouri is home to 950,000 seniors. Dunn stated this number will more than double to two million seniors in the next three or four years. Currently seven percent of the senior population is in nursing homes. To meet these estimated numbers in the future, either the number of nursing home beds must rise or the percentage of seniors residing in nursing homes must drop to four percent.

In addition to the growing senior population, Dunn also pointed to a need for change in the industry, which is still often based on a 30-year old model.

"We must help our industry become better," Dunn said. "Thirty years ago we began to see the evolution of nursing home services when Medicaid really kicked in. At that time the services were predominantly provided to those who weren't really sick. These programs worked then, but now we must consider higher levels of care and specialized services for the greater needs of a growing number of patients."

Dunn explained the shift in care provided by nursing homes over this period, noting that a large number of residents in nursing homes likely would have been patients at hospitals 30 years ago and not in a residential care facility.

"Residents are living longer which poses greater challenges to meet all the needs of the patients," Dunn said. "The old model was not designed to accommodate the special needs and high medical service require-ments that we are seeing."

Now the service provided by nursing homes of old is being provided at home through home health care agencies. Now most residents are not entering nursing homes until they are forced to for medical reasons.

"We can't destroy the system, we simply must make it better," Dunn said. "We must introduce new techniques for new seniors that are going to be needing care in the future. We definitely have gained the ability to prolong life. Now we must be able to prolong the quality of life as well."

Carol Rodriguez testified to the committee regarding the biggest increasing specialization of care area, Alzheimer's Disease. She informed the committee members of the 100,000 Missourians that suffer from the disease. The numbers reach four million in the United States and are expected to grow to 14 million in the recent future.

Rodriguez stated the dramatic increase can be traced to the figures presented by Dunn regarding the rapidly increasing seniors population. She said that half of the nation's population over the age of 85 suffer from some form of dementia.

Alzheimer's Disease creates a large problem for the nursing home industry because of the nature of the illness. The average Alzheimer's patient lives for eight years after diagnosis with many living as much as 20 years.

Rodriguez also pointed out the growing cost of serving these residents. The average expense is $174,000 per individual.

She also pointed to home care issues, indicating as many as 70 percent of Alzheimer's patients are cared for at home, at least in the early stages of the disease. She noted that in-home health care, adult daycare and respite care can delay nursing home placement by an average of 300 days.

The number one issue created by the growing Alzheimer's problem is staffing said Rodriguez. There is a growing need for nursing career professionals that are appropriately trained to do the very difficult tasks involved with the disease she noted.

Rodriguez noted that Certified Nursing Assistants (CNAs) is the fastest growing national employment field. However the average national compensation level for CNAs is just $7.56. That compares to an average salary of $8.74 in retailed sales and more than $10 for unskilled factory employees.

Another trouble area noted by Rodriguez was the Medicaid guidelines, specifically the qualifying level that disqualifies anyone with cash assets of more than $1,000. She noted this figure had not been changed in more than 30 years.

Rodriguez gave the committee two recommendations. First, to maintain and maximize the in-home family care option for Alzheimer's patients. Secondly, she suggested the committee make every effort to sustain affordable medical care options for both citizens and the state.

Barbara Primm, of the Lockhead Care Facility in Macon told the committee the quality of care is a direct result of having adequate numbers of well-trained staff. She noted that the number and type of staff need to be related to care needs not just the number of patients.

Primm also addressed the state's quality control measures. She noted the state's survey process is often adversarial. She questioned why the survey process does not scrutinize the poorer facilities and leave the good ones alone.

The industry is facing a shortage of nurses that is comparable to what the education field is experiencing with a lack of teachers, Primm told the committee. She suggested making assistance available for education, transportation and childcare needs of prospective nursing employees. Primm also suggested lowering the restriction from 18 to 17 years of age to earn a CNA degree.

Currently CNA training goes on either in the nursing facility or in an area vocational technical school. It requires 75 classroom hours as well as 100 hours of on the job training.

The final main topic of discussion was the declining Medicaid reimbursement numbers for nursing homes. Robert Seamster, administrator of the Schuyler County Nursing Home told the committee that a recent study of care centers across the Midwest noted an average loss of $8.91 per day, per Medicaid patient.

He noted that much of the problem lies in the fact the maximum rates were set in 1995 and were based on 1992 cost reports.

He also cited a price index study that revealed a 22.4 percent increase in the consumer price index between 1984-89. During that same period the medical price index increased by 41.7 percent. Yet Seamster noted the Medicaid rate only increased 13.5 percent over that time frame.

Seamster told the committee that the Medicaid system must be looked at to allow nursing homes at least the ability to break even.

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